Adult celiac disease: patients are shorter compared with their peers in the general population

Background: Delay in diagnosis of celiac disease [CD] occurs frequently, although its consequences are mostly not known. One of the presented symptoms in pe-diatric patients with CD is the short stature. However, far too little attention has been paid to physical features including height of adult patients with CD. This study was undertaken to evaluate whether patients suffering from CD are shorter in comparison with the general population without CD. As well, we evaluated probable correlations between demographic and physical features, main complains, serum anti tTG level, and intestinal pathology damage between short [lower quartile] versus tall stature [upper quartile] patients with CD

Methods: This was a retrospective cross-sectional study on 219 adult patients diagnosed as having CD in the Celiac Disease Center, between June 2008 and June 2014 in Mashhad, Iran. The exclusion criteria were ages less than 18 and more than 60 years. Height was compared with a group of 657 age- and sex-matched control cases from the healthy population. The probable influencing factors on height such as intestinal pathology, serum level of anti-tissue trans- flutaminase [anti-tTG], serum vitamin D, and hemoglobin level at the time of diagnosis were assessed and were compared in short [lower quartile] versus tall stature [upper quartile] patients with CD

Results: Both male [n=65] and female [n=154] patients with CD were shorter than their counterpart in the general population [males: 168.5+/-8.6 to 171.3+/-7.2 cm,p<0.01 and females: 154.8+/-10.58 to 157.8+/-7.2 cm, p<0.01. Spearman linear correlation showed height in patient with CD was correlated with serum hemoglobin [p<0.001, r=0.285] and bone mineral density [p<0.001] and not with serum vitamin D levels [p =0.024, r=0.237], but was not correlated with anti-tTG serum levels [p=0.97]

CD patients with upper and lower quartile of height in men and women had no significant difference in the anti-tTG level and degree of duodenal pathology [Marsh grade]

Anemia as main complaint was more prevalent in shorter versus taller men

Conclusion: Adults with CD are shorter compared with healthy adults. There is a direct correlation between height and anemia and bone mineral density This finding highlights the importance of early detection and treatment of CD

Correlation between cut-off level of tissue transglutaminase antibody and marsh classification

Background: Duodenal biopsy is required for diagnosis of celiac disease in adults, although some studies have suggested adequate accuracy of serology alone

Objective: We aimed to assess the correlation between anti-tissue transglu-taminase [tTG] titer and pathological findings and to define the specific level of tTG for predicting celiac disease in adults without the need for biopsy sampling

Methods: This descriptive study was done on 299 participants

The tTG titer and pathological findings of duodenal biopsy samples were used for this study Analysis of Receiver operating characteristic [ROC] curve was used to find a cut-off point of anti-tTG antibody for mucosal atrophy

Results: Mean tTG titers was significantly higher in patients graded as Marsh III>/= 3 [p=0.023]. ROC curve analysis showed 89.1% sensitivity for cut-off point>/=76.5 lU/mL of anti-tTG. For Marsh>/= II, specificity was 28% and positive predictive value was 91%

Conclusion: There is a linear correlation between increasing tTG level and Marsh I to III. Specificity of tTG titer more than 200 was 100% for Marsh >2.

Impact of short-term, repeated water fasting on the weight of mice

Caloric restriction is a strategy applied for weight loss. Water fasting is a popular way for obesity treatment. However, little is known about the impact of water fasting on weight. Therefore, this study was conducted to investigate the effect of shortterm, repeated water fasting on the weight of mice. In this study, the physiological effect of short-term, repeated water fasting on the weight of female mice was evaluated. At 6 weeks of age, mice were randomly assigned to either repeated-fasting or control group [fed ad libitum]. Each group consisted of twenty mice. As the fasting period started, the repeated-fasting group had access to only water; animals had free access to food and water on non-fasting days. Body weight of each group before, during, and after the fasting period was recorded. Body weight of the fasting group significantly decreased, unlike the control group. However, the fasting group gained weight rapidly after being re-fed and became significantly heavier than mice in the control group [P<0.01]. Interestingly, the average body weight of the fasting group increased, compared to that of the control group; in fact, the fasting mice weighed approximately 10% heavier than the control ones. Repeated water fasting was not only ineffective for weight loss but also increased the body weight of fasting mice

Diagnostic value of ASCA and atypical p-ANCA in differential diagnosis of inflammatory bowel disease

Worldwide, the incidence of inflammatory bowel disease [IBD] is increasing. This study aims to evaluate the diagnostic value of two serological markers, atypical perinuclear anti-neutrophil cytoplasmic antibodies [atypical-P-ANCA] and anti-Saccharomyces cerevisiae antibodies [ASCA], with the intent to determine their relationship to ulcerative colitis [UC] and Crohn's disease [CD], in addition to the location and extent of bowel involvement. There were 97 patients enrolled in this study, 72 diagnosed with UC and 25 with CD. The control group consisted of 40 healthy individuals. ASCA was determined by enzyme-linked immunosorbent assay [ELISA] and atypical-P-ANCA by indirect immunofluorescence assay [IIF]. For data analyses, we used the chi-square and independent t-tests. Significance was considered to be p<0.05. For CD, the sensitivity of ASCA was 16% and its specificity was 97%. ASCA had a specifity of 90% in UC patients. The atypical P-ANCA test had a sensitivity of 44% and specificity of 86% for UC. The positive predictive value [PPV] for atypical P-ANCA in UC patients was 78% and for the negative predictive value [NPV], it was 58%.There was no correlation between ASCA and atypical P-ANCA results and the location of gastrointestinal [GI] involvement in CD [p=0.61] and UC [p=0.28] patients. According to the results, ASCA and atypical P-ANCA markers are not useful for IBD screening. Our study suggests that atypical P-ANCA is a useful parameter to differentiate UC from CD. However, ASCA is of limited value for screening and differentiating UC from CD

[ case report of nodular regenerative hyperplasia of the liver and coeliac disease]

Coeliac disease [CD] is an autoimmune enteropathy triggered by gluten. Several hepatic disorders have been described in association with coeliac disease. Nodular regenerative hyperplasia [NRH] of the liver is a rare disorder and is a cause of non-cirrhotic portal hypertension. A 22 y/o lady presented with portal hypertension, after all causes of chronic liver disease ruled out we checked for coeliac and it was positive. Liver biopsy was done and was compatible with nodular regenerative hyperplasia [NRH] of the liver. As far as we know this is one of the rare cases of nodular regenerative hyperplasia of the liver in a patient with coeliac. Only three cases have been reported until now and seems we should think about coeliac in any patient suffering from chronic liver disease with unknown cause

Acute effect of water pipe smoke on sensitized animals

This study aimed to compare the inflammatory effects of water pipe smoke with cigarette smoke on inducing exacerbation in asthmatic murine model, under similar conditions of exposure. Thirty-six BALB-C mice in six different groups [one control group, one asthmatic group and four groups of asthmatic exposed to smoke] were entered the study. Animals were exposed to cigarette and water pipe smokes and samples were obtained after 6 and 24 hours. Bronchoalveolar lavage fluid [BALF] was collected and analyzed for neutrophils, eosinophils, nitric oxide, Interferon-gamma [IFN-delta] and lnterleukin-4 [IL-4]. Serum Interferon-gamma and IL-4 were also evaluated. Both lungs were sent for histopathological examination. In all sensitized animals, BALF cytology showed a significant decrease in neutrophils and lymphocyte percentage and significant increase of eosinophils. The level of nitric oxide in all smoke exposed animals was significantly higher than sensitized controls. Water pipe smoke did not affect the IL-4 level, but cigarette smoke decreased IL-4 after 6 hours. The level of IFN-gamma in BALF decreased after 6 hours of exposure in both exposed groups and returned to baseline after 24 hours. Exacerbation of asthma by water pipe smoke is comparable to that of cigarette smoke. The mechanism of action may be through the suppression of the type 1 T helper cells